What is a tongue or lip tie? 
Tongue or ankyloglossia occurs when tongue movement is restricted by the presence of a short, tight but thin membrane (frenulum) which stretches from the underside of the tongue to the floor of the mouth.
Both the Tongue (lingual frenulum) and Upper Lip (maxillary labial frenulum) exist in early pregnancy. As baby develops the tongue separates from the floor of the mouth and the gum. The cells regress/disappear along the mid-line from the tip of the tongue leaving a small strand of tissue at the back (the lingual frenulum).
This strand of tissue is a normal part of anatomy. However, when it is short, tight, and inelastic, extends along the underside of the tongue or is attached close to the lower gum it can interfere with the normal movement and function of the tongue.
Upper lip, labial frenulum normally extend from the lip to the gum line at various joining points but can be stretched and very rarely causes issues with feeding. They often serve as a normal tooth spacer for later life and therefore research does not support the treatment of lip ties.
How do tongue-ties affect breastfeeding?
‘The tongue is the major “player” in breastfeeding. It helps pull the breast into proper position in the mouth, then grooves along its length to make a channel to keep the breast in place in the mouth and to catch milk to hold it at the back of the tongue in preparation for swallowing.’ Catherine Watson Genna, 2002
‘If the baby’s frenulum is too short that his tongue can’t extend over the lower gum, he may end up compressing the breast tissue between his gums while he nurses, which can cause nipple soreness or damage. Some tongue-tied babies are able to nurse effectively, depending on the way the frenulum is attached, as well as the individual variations in the mother’s breast. If the mother has small or medium nipples, the baby may manage to extract the milk quite well in spite of being tongue-tied. On the other hand, if the nipples are large and/ or flat/inverted, then even a slight degree of tongue-tie may cause problems for a breastfeeding baby.’ Anne Smith, 2013
Babies with restricted tongue movement and function may have difficulty latching, maintaining a seal, co-ordinating their suck-swallow-breathe rhythm resulting in inefficient feeding, and an array of symptoms experienced by both mother and baby that negatively affect breastfeeding and comfort during feeding,
Infants with Upper lip tie very rarely require treatment.
Signs and Symptoms of Tongue ties
“An infant’s inability to breastfeed often results in its mother giving up breastfeeding entirely as well as being told that the problem is their fault. In reality, the problems may actually result from the tongue attachments to the rest of the oral structures in a way that is abnormal and makes normal function and mobility difficult or impossible.” Dr Lawrence Kotlow.
| Signs in Baby | Signs in Mother |
| •poor latch and suck •unusually strong suck due to baby using excess vacuum to remove milk •clicking sound while nursing (poor suction) •ineffective milk transfer •infrequent swallowing after initial let-down •inadequate weight gain or weight loss •irritability or colic •gas and reflux •fussiness and frequent arching away from the breast •difficulty staying latched or getting a deep latch•breast sliding in and out of baby’s mouth while feeding •baby slipping on and off or gradual sliding off the breast •chewing/clamping or biting on the nipple •falling asleep at the breast without taking in a full feed •coughing, choking, gulping, or squeaking when feeding •spilling milk during feeds •jaw quivering after or between feeds |
•persistent nipple pain and/or damage •nipple looks pinched, creased, bruised, or raw after feeds •white stripe at the end of the nipple •painful breasts/vasospasm •low milk supply •plugged ducts or mastitis •recurring thrush •frustration, disappointment, and discouragement with breastfeeding •weaning before mother is ready |